Sources of Hospital Variation in Short-Term Readmission Rates After Percutaneous Coronary…

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Prognostic Significance of Elevated Baseline Troponin in Patients With Acute Coronary Syn…

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Antithrombotic therapy in patients with atrial fibrillation undergoing coronary stenting: a north american perspective: executive summary.
Circ Cardiovasc Interv. 2011 Oct 1;4(5):522-34
Authors: Faxon DP, Eikelboom JW, Berger …

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Effects of Hydration in Contrast-Induced Acute Kidney Injury After Primary Angioplasty: A Randomized, Controlled Trial.
Circ Cardiovasc Interv. 2011 Oct 4;
Authors: Maioli M, Toso A, Leoncini M, Micheletti C, Bellandi F
…

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Clinical Outcomes in Patients With the Concomitant Use of Clopidogrel and Proton Pump Inhibitors After Percutaneous Coronary Intervention: An Analysis From the Guthrie Health Off-Label Stent (GHOST) Investigators.

Circ Cardiovasc Interv. 2011 Mar 8;

Authors: Harjai KJ, Shenoy C, Orshaw P, Usmani S, Boura J, Mehta RH

Background-The concomitant use of proton pump inhibitors (PPIs) with clopidogrel is suspected to be associated with an adverse impact on clinical outcomes in patients with coronary artery disease. We sought to evaluate whether the use of PPIs with clopidogrel was associated with worse clinical outcomes after percutaneous coronary intervention (PCI) compared with the use of clopidogrel alone. Methods and Results-We studied 2651 consecutive patients discharged alive after coronary stenting for stable or unstable coronary artery disease between 2001 and 2007. All patients received aspirin indefinitely and a thienopyridine for 1 to 12 months. Patients were categorized into 2 groups: those taking a PPI [PPI (+), n=751] and those not taking a PPI [PPI (-), n=1900] at discharge. The primary end points were the 6-month incidence of major adverse cardiovascular events (MACE) (composite of death, myocardial infarction, target vessel revascularization, and stent thrombosis) and net adverse clinical events (NACE) (composite of MACE and thrombolysis in myocardial infarction major or minor bleeding), which were evaluated using propensity-adjusted Cox regression analysis. In addition, propensity-matched analysis was performed in 685 pairs of patients. The PPI (+) group was older and had more comorbid conditions than the PPI (-) group. In propensity-adjusted as well as propensity-matched analyses, the use of PPIs was not associated with an increased risk of MACE or NACE. Conclusions-The use of PPIs with dual antiplatelet therapy was not associated with any adverse influence on MACE or NACE after PCI.

PMID: 21386091 [PubMed - as supplied by publisher]

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A Randomized Controlled, Phase 2 Trial of the Viral Serpin Serp-1 in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention.

Circ Cardiovasc Interv. 2010 Nov 9;

Authors: Tardif JC, L’allier PL, Grégoire J, Ibrahim R, McFadden G, Kostuk W, Knudtson M, Labinaz M, Waksman R, Pepine CJ, Macaulay C, Guertin MC, Lucas A

Background-Vascular inflammation can lead to plaque instability and acute coronary syndromes (ACS). Viruses produce potent immunomodulating proteins that regulate key inflammatory pathways. A myxoma virus-derived serpin Serp-1 reduces inflammatory cell invasion and plaque growth in vascular injury models. Our objective was to evaluate the safety and efficacy of Serp-1 in patients with ACS undergoing percutaneous coronary intervention. METHODS AND RESULTS: <0.05) and in creatine kinase-MB levels at 8, 16, and 24 hours after dose (P<0.05). The composite of death, myocardial infarction, or coronary revascularization occurred in 2 of 12 patients with placebo, 5 of 19 in the low-dose group, and none of 17 patients with the high-dose (P=0.058). Intravascular ultrasound did not detect changes in neointimal hyperplasia among groups. Conclusions-This is the first study of a viral serpin demonstrating its safety in ACS patients. The significant reduction in myocardial damage biomarkers supports further assessment of Serp-1 in ACS patients undergoing stent deployment. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00243308.

PMID: 21062996 [PubMed - as supplied by publisher]

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Mehran Contrast-Induced Nephropathy Risk Score Predicts Short- and Long-Term Clinical Outcomes in Patients With ST-Elevation-Myocardial Infarction.

Circ Cardiovasc Interv. 2010 Oct 5;

Authors: Sgura FA, Bertelli L, Monopoli D, Leuzzi C, Guerri E, Spartà I, Politi L, Aprile A, Amato A, Rossi R, Biondi-Zoccai G, Sangiorgi GM, Modena MG

Background-The Mehran Risk Score (MRS) has been demonstrated to be clinically useful for prediction of contrast-induced nephropathy (CIN) after nonurgent percutaneous coronary intervention. We aim to validate the MRS in the setting of Primary percutaneous coronary intervention for prediction of both CIN and short- and long-term clinical outcomes. METHODS AND RESULTS: <0.001) when compared with the low-risk group and was also increased in the high-risk group (HR, 6.31; 95% CI, 3.28 to 12.14; P<0.001) and medium-risk group (HR, 3.18; 95% CI, 1.83 to 5.51; P<0.001). Similarly, an increasing effect was seen across MRS strata for major cardiovascular and cerebrovascular events both in the very high-risk group (HR, 3.79; 95% CI, 2.27 to 6.6.32; P<0.001), high-risk group (HR, 1.90; 95% CI, 1.31 to 2.75; P=0.001), and medium-risk group (HR, 1.42; 95% CI, 1.10 to 1.85; P=0.007). In addition, the HR for rehospitalization increased with the increasing RC groups (HR, 3.32; 95%CI, 1.96 to 5.63; P<0.001; HR, 3.11; 95% CI, 1.35 to 7.20; P=0.008; HR, 7.73; 95% CI, 2.97 to 20.10; P<0.001, respectively). The odds ratio for CIN was 2.84 (95% CI, 1.16 to 6.92; P=0.021) in the very high RC group, 1.33 (95% CI, 0.68 to 2.61; P=0.398) in the high RC group, and 1.10 (95% CI, 0.67 to 1.79; P=0.699) in the medium RC group, as compared with the lower one. Conclusions-The MRS may be applied in the primary angioplasty setting population and is able to predict CIN and to stratify patients for poor clinical outcomes both in the short- and long-term follow-up.

PMID: 20923986 [PubMed - as supplied by publisher]

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Prognostic Value of Isolated Troponin I Elevation After Percutaneous Coronary Intervention.

Circ Cardiovasc Interv. 2010 Oct 5;

Authors: Cavallini C, Verdecchia P, Savonitto S, Arraiz G, Violini R, Olivari Z, Rubartelli P, De Servi S, Plebani M, Steffenino G, Sbarzaglia P, Ardissino D,

Background-Mild elevations of cardiac troponin are frequent after percutaneous coronary intervention (PCI). Their prognostic value is uncertain in the absence of changes in creatine kinase-MB (CK-MB). METHODS AND RESULTS: =0.069). A cTnI elevation >0.45 ng/mL was associated with a higher risk of mortality (4.5% versus 2.7%; hazard ratio, 1.68; 95% confidence interval, 1.01 to 2.80; P=0.044), which, however, did not remain significant after adjustment for concomitant risk factors (hazard ratio, 1.45; 95% confidence interval, 0.86 to 2.46; P=0.162). Postprocedural cTnI elevation was associated with coronary and clinical features consistent with a worse risk profile. Conclusions-In the absence of a rise in CK-MB, elevated cTnI levels after PCI are associated with a modest increased risk of death. However, this is not independent of the concomitant adverse baseline clinical characteristics of these patients.

PMID: 20923987 [PubMed - as supplied by publisher]

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